Behavioral Health Telepsychiatry

On-demand Telepsychiatry, where an emergency department (ED) or other acute setting can pay for psychiatric evaluations only when they need it, helps hospitals and systems. This saves smaller EDs and communities from having to pay for 24-hour coverage when they might only have a handful of patients per day or per week. This can also be more effective than having mobile teams visit EDs, as having psychiatrists evaluate patients means that medications can be prescribed, medical issues can be examined and differentiated, and 5150s can be discontinued when appropriate.

Many provider programs are interested in using on-demand telepsychiatry, but are reluctant for two reasons. The legislature could encourage on-demand telepsychiatry with no need for any new allocated funds or start-up costs to the State by simply adding to State law that:

1) Psychiatric Holds such as 5150 holds may be discontinued by a Psychiatrist evaluating a patient via Telepsychiatry
2) Medi-Cal may be billed for Crisis Intervention, Crisis Stabilization and Medication Management via Telepsychiatry in the same way as in-person.

Merely having these changes in the law would likely encourage EDs to seek this service, and encourage psychiatrist groups to provide this service as they do in several other states.

Advantages of On-Demand Telepsychiatry in EDs:

Improve emergency department throughput

Evaluations provided within one hour or less (typical wait for onsite consultation can be many hours, even days)

Reduced regular staff stress due to fewer after-hours calls

Pay-as-you-go, just-in-time increase in capacity to meet nearly any surge in demand

Decrease intangible costs: psychological and social burdens imposed on the mentally ill person, his or her family, and the larger society.

Provide access to persons who cannot or will not come emergency rooms.

Assist patients successfully diverted from jail to a PES by law enforcement officers and Crisis Intervention Teams.

Provide “wrap around” services linking patients to ongoing psychiatric care rather than allowing them to recycle in crisis among the streets, emergency rooms, hospitals, and jails.

The Burke Center chose telepsychiatry to provide 100% of its psychiatric services in its new MHEC facility, constructed with telepsychiatry in mind in 2008. The MHEC incorporates a psychiatric emergency service with a telemedicine suite; a six-bed, secure Extended Observation Unit; and an open, 16-bed Crisis Residential Unit. In addition, Burke’s Mobile Crisis Outreach Team, housed in the same building, has its own telepsychiatry suite.

All Burke’s psychiatric evaluations are done via telemedicine, for both voluntary and involuntary patients. A psychiatrist has never been physically present in the MHEC facility to do an evaluation.

By any standard, services at the Burke Center have been a resounding success. Since 2008, over 3,400 patients have been evaluated with high satisfaction rates from both patients and staff. Over 95% percent of patients seen have rated their care with “Satisfied” or “Very Satisfied” ratings. The Burke Center has won the American Psychiatric Association’s Gold Award for Innovation in 2011, the National Council for Behavioral Healthcare’s Innovators Award in 2013, and the Mental Health Corporations of America’s Customer Satisfaction Award in 2013.

On-demand Telepsychiatry, where an emergency department (ED) or other acute setting can pay for psychiatric evaluations only when they need it, helps hospitals and systems. This saves smaller EDs and communities from having to pay for 24-hour coverage when they might only have a handful of patients per day or per week. This can also be more effective than having mobile teams visit EDs, as having psychiatrists evaluate patients means that medications can be prescribed, medical issues can be examined and differentiated, and 5150s can be discontinued when appropriate.

Many provider programs are interested in using on-demand telepsychiatry, but are reluctant for two reasons. The legislature could encourage on-demand telepsychiatry with no need for any new allocated funds or start-up costs to the State by simply adding to State law that:

1) Psychiatric Holds such as 5150 holds may be discontinued by a Psychiatrist evaluating a patient via Telepsychiatry
2) Medi-Cal may be billed for Crisis Intervention, Crisis Stabilization and Medication Management via Telepsychiatry in the same way as in-person.

Merely having these changes in the law would likely encourage EDs to seek this service, and encourage psychiatrist groups to provide this service as they do in several other states.

Advantages of On-Demand Telepsychiatry in EDs:

Improve emergency department throughput

Evaluations provided within one hour or less (typical wait for onsite consultation can be many hours, even days)

Reduced regular staff stress due to fewer after-hours calls

Pay-as-you-go, just-in-time increase in capacity to meet nearly any surge in demand

Decrease intangible costs: psychological and social burdens imposed on the mentally ill person, his or her family, and the larger society.

Provide access to persons who cannot or will not come emergency rooms.

Assist patients successfully diverted from jail to a PES by law enforcement officers and Crisis Intervention Teams.

Provide “wrap around” services linking patients to ongoing psychiatric care rather than allowing them to recycle in crisis among the streets, emergency rooms, hospitals, and jails.

The Burke Center chose telepsychiatry to provide 100% of its psychiatric services in its new MHEC facility, constructed with telepsychiatry in mind in 2008. The MHEC incorporates a psychiatric emergency service with a telemedicine suite; a six-bed, secure Extended Observation Unit; and an open, 16-bed Crisis Residential Unit. In addition, Burke’s Mobile Crisis Outreach Team, housed in the same building, has its own telepsychiatry suite.

All Burke’s psychiatric evaluations are done via telemedicine, for both voluntary and involuntary patients. A psychiatrist has never been physically present in the MHEC facility to do an evaluation.

By any standard, services at the Burke Center have been a resounding success. Since 2008, over 3,400 patients have been evaluated with high satisfaction rates from both patients and staff. Over 95% percent of patients seen have rated their care with “Satisfied” or “Very Satisfied” ratings. The Burke Center has won the American Psychiatric Association’s Gold Award for Innovation in 2011, the National Council for Behavioral Healthcare’s Innovators Award in 2013, and the Mental Health Corporations of America’s Customer Satisfaction Award in 2013.